Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 37085 | NC |
NPI | 1396994364 |
---|---|
Provider Name | Adam David Marion |
First Address | Stella, NC 28582-9741 |
Second Address | Stella, NC 28582-9741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 15/09/2008 |